Diabetic foot ulcer

Biofilms have been implicated in numerous chronic infections including cystic fibrosis and prostatitis. Through interactions within a biofilm, the resident population of bacteria is likely to benefit from increased metabolic efficiency, substrate accessibility, enhanced resistance to environmental stress and inhibitors, and an increased ability to cause infection and disease. Dermal wounds often provide an ideal environment for bacteria to exist as a community, which may have a significant effect on wound healing. The conditions under which species of microorganisms can survive in nature are determined by physiological and ultimately genetic competence. Consequently, species of bacteria often rely on close relationships with other species for survival and reproductive success. A biofilm forms when bacteria attach to a surface and subsequently encase themselves in an exopolymeric material (Costerton et al., 1999). Some bacteria are morphologically and physiologically different from free-living planktonic bacteria and have implicated in numerous chronic infections ranging from cystic fibrosis to prostatitis (Costerton et al., 1995). The existence of biofilms in an acute partial-thickness wound (Serralta et al., 2001) and in chronic human wounds (Bello et al., 2001) has been documented.

A diabetic foot ulcer is an excellent example of a chronic wound that responds well to management using biofilm principles (Dowd et al., 2008). Bacteria within biofilms have been reported to be up to 500 times more resistant to antibiotics than planktonic (unattached, freely living) cells (Donlan, 2001; Donlan and Costerton, 2002). Most of the chronic wound pathogens, such a methicillin-resistant S. aureus (MRSA) and Pseudomonas spp., are typical biofilm producers. Bacteria that reside within mature biofilms are highly resistant to many traditional therapies. Bacteria in biofilms grow more slowly, and slower growth may lead to decreased uptake of the drug and other physiologic changes that could impair drug effectiveness (Mandell et al., 2005). Currently, one of the most successful strategies for the management of biofilm-related conditions is physical removal of the biofilm, such as frequent debridement of diabetic foot ulcers (Davis et al., 2006).

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